Understanding eating disorders in French undergraduate students: gender gaps, lifestyle factors, and barriers to care

BACKGROUND: University students are at increased risk of eating disorders (EDs) due to academic pressure, financial strain, and social stressors. OBJECTIVE: The aim of this study was to estimate ED prevalence among undergraduate students in France and identify associated factors, including gender identity, socioeconomic hardship, field of study, lifestyle behaviors, psychiatric comorbidities, and healthcare avoidance. METHODS: A cross-sectional online survey was conducted among undergraduates students. ED diagnosis was based on self-report. Multivariable logistic regression models assessed associations between ED and sociodemographic, health-related, and behavioral factors, adjusting for age, sex, and field of study. RESULTS: Among 2,678 respondents (75.2% women; mean age 20.2 ± 1.6 years), 6.7% (95% CI 5.7-7.6) reported ED: 7.7% of women, 2.8% of men, and 35.2% of non-binary students (p < 0.01). ED was strongly associated with non-binary identity, obesity, negative body image, financial difficulties, poor self-rated health, psychiatric disorders, and recent suicide attempts. Behavioral correlates included daily lunch skipping, poor sleep quality, and frequent substance use. Students with ED more often avoided healthcare, with 40.5% avoiding general practitioners and 51.7% psychiatrists versus 15.2% and 15.7% among peers without ED (p < 0.001). Main reasons included financial barriers, fear of seeking care, and absence of a regular physician. CONCLUSIONS: EDs affect a substantial proportion of undergraduate students, with marked vulnerability among non-binary individuals. The findings highlight interactions between socioeconomic stress, body image, behavioral factors, and psychiatric comorbidity. Frequent healthcare avoidance underscores the need for accessible, inclusive, and stigma-free prevention and care strategies within universities.